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NYS Health Insurance Transaction Form (PS-404) - cs ny 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the Employee Information section. Enter your Last Name, First Name, Middle Initial, Social Security Number, and Date of Birth. Ensure all fields are completed accurately.
- Next, provide your contact details including Street Address, City, State, Zip Code, and Telephone Numbers. This information is crucial for communication regarding your health insurance.
- Indicate your Marital Status and whether you are covered under Medicare. This helps determine eligibility for certain plans.
- In the Request(s) section, select your desired enrollment options such as Individual or Family coverage and specify if you wish to elect Pre-Tax Status for premium deductions.
- Complete the Dependent Information section if applicable. Use additional sheets if necessary to include all dependents.
- Finally, review the Leave Without Pay and Retirement sections to confirm your choices regarding coverage during these periods before signing and submitting the form.
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What is a PS form 2548?
New employee training must be recorded on PS Form 2548, Individual Training Record. The training agent (the LDDS or the employees job instructor) and the immediate supervisor complete PS Form 2548. The LDDS retains the form at a central location, which the training supervisor or manager determines.
What is a PS form 3883?
United States Postal Service Firm Delivery Receipt for Accountable and Bulk Delivery Mail.
How to renew NYS health insurance?
Renew Over the Phone 1-855-355-5777 (TTY: 1-800-662-1220). The Customer Service Center is open Monday through Friday from 8:00 AM to 8:00 PM and on Saturday from 9:00 AM to 1:00 PM.
What is a PS 404 form?
Use to sign up for health insurance or make changes to your existing benefits.
How to apply for NYS health insurance?
There are three ways to enroll in health insurance through NY State of Health: Apply online through the NY State of Health website. By phone at 1-855-355-5777 (TTY: 1-800-662-1220) With the free help of a trained and certified Enrollment Assistor or Broker.
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